Rutherford First Aid Ambulance Corps Interest Form
Thank you for your interest in joining the Rutherford First Aid Ambulance Corps, Inc.
Our organization is actively recruiting new members to provide volunteer ambulance service to the Borough of Rutherford as certified Emergency Medical Technicians (EMT).

Upon receipt of your application we will invite you for an interview with our membership committee.
Sign in to Google to save your progress. Learn more
Legal First Name *
Legal Last Name *
Residential Address *
City *
State *
ZIP Code *
Phone Number for Contact *
Email *
Date of Birth *
MM
/
DD
/
YYYY
Do You Have A CPR Certification *
If You Already Have Your CPR Certification, Please Indicate Date of Expiration Else Pease Leave Blank
MM
/
DD
/
YYYY
Do You Have a NJ EMT or NREMT Certification? *
If You Already Have Your NJ EMT or NREMT Certification, Please Indicate Date of Expiration Else Pease Leave Blank.
MM
/
DD
/
YYYY
If elected to membership, I agree to serve the ambulance corps to the best of my ability in accordance with the by-laws, and to fully perform duties as may be assigned to me. I further agree to surrender promptly any and all property of the ambulance corps whenever I shall cease to be a member, or upon written request.

Typing full name implies consent as e-signature.
 *
Parent signature if a minor.

Typing full name implies consent as e-signature.
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms